| Entity Name: | MOSS CHIROPRACTIC CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Jul 2008 (17 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 08 Oct 2012 (12 years ago) |
| Document Number: | L08000066125 |
| FEI/EIN Number | 364616151 |
| Address: | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL, 34952, US |
| Mail Address: | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL, 34952, US |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194058321 | 2009-09-04 | 2009-09-04 | 4361 NORTHLAKE BLVD, PALM BEACH GARDENS, FL, 334106253, US | 4361 NORTHLAKE BLVD, PALM BEACH GARDENS, FL, 334106253, US | |||||||||||||||||||||||||
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| Phone | +1 561-627-7771 |
| Fax | 5616275948 |
Authorized person
| Name | DR. DAMON T MOSS |
| Role | PRESIDENT |
| Phone | 5616272287 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9024 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CIGNA HEALTHCARE |
| Number | 8584749 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOSS DAMON T | Agent | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| MOSS DAMON | Manager | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL, 34952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-21 | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL 34952 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-21 | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL 34952 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-21 | 1580 SE PORT ST LUCIE BLVD., PORT ST LUCIE, FL 34952 | No data |
| REINSTATEMENT | 2012-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-21 |
| ANNUAL REPORT | 2023-04-21 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-01-07 |
| ANNUAL REPORT | 2016-04-02 |
| ANNUAL REPORT | 2015-04-22 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7809047710 | 2020-05-01 | 0455 | PPP | 4361 NORTHLAKE BLVD, PALM BEACH GARDENS, FL, 33410 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4925508401 | 2021-02-07 | 0455 | PPS | 4361 Northlake Blvd, Palm Beach Gardens, FL, 33410-6253 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
